Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 37810 | CA |
NPI | 1003100017 |
---|---|
Provider Name | Emily Richard |
First Address | San Diego, CA 92110-5254 |
Second Address | San Diego, CA 92109-8729 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2011 |
Last Update Date | 02/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
W17206 | (02) | CA |